In the past, just hearing the term “root canal” caused many patients to shudder at the very prospect of that onerous dental procedure. But those days are gone. Endodontics — the branch of dentistry dealing with problems in the root, pulp, and/or surrounding tissue of the teeth — now features an arsenal of high-tech tools that make procedures like root canals easier for dentists and patients alike.
A root canal is generally done to save a tooth when the pulp — the soft tissue tucked deep inside the tooth — is diseased or injured.
Common pulp problems — usually caused by bacteria — might result from a cracked tooth, a deep cavity, issues involving large fillings, or serious injury. During root canal treatment, the pulp is removed; the area is cleaned out and disinfected, then filled and sealed with a rubber-like material. Finally, the tooth is restored with a crown or filling.
WHAT’S NEW: Magnifying glasses for dentists that use fiber optic light and surgical operating microscopes both help endodontists see deep into the root canal for more-thorough treatment; nickel titanium filing tools to clean out the pulp (some dentists now use lasers that “melt away” infection); and electronic gizmos that utilize sound waves (think sonar in submarines) to measure the “depth” of the pulp area.
LITTLE BITES: Researchers were surprised when a skull found in Israel dating from the second or third century B.C. turned out to have a bronze wire stuck in one of its teeth. Experts surmise it might have been a very early “treatment” for an infected root canal.
Oral and Maxillofacial Surgery
The only dental subspecialty recognized by the American Dental Association, oral and maxillofacial surgery involves treatment for various diseases and injuries affecting the face. An oral and maxillofacial surgeon removes impacted teeth (“wisdom teeth,” for instance); performs dental implants; fixes deformities of the mouth, teeth, jaws, and face; and offers cosmetic options, too. Other than anesthesiologists, they are also the only specialists in healthcare trained to administer all levels of sedation and general anesthesia.
WHAT’S NEW: Oral and maxillofacial surgeons are leaders in implant technology. New techniques include bone grafting in areas of the mouth where little or no bone previously existed. The “sinus lift” is a bone-grafting procedure used when the upper jaw isn’t healthy enough to accommodate an implant.
LITTLE BITES: Forget the tooth fairy. More and more dental patients, especially younger ones, are having their teeth saved after extraction in order to preserve the dental stem cells for the future, says the American Association of Oral and Maxillofacial Surgeons.
Technically speaking, orthodontics focuses on preventing and correcting irregularities of the teeth, bite, and jaws. But to most of us, orthodontists are the dental experts who give us braces — with an end result of gleaming, straight choppers. The field has a long history — the first treatment for correcting irregular teeth was reportedly suggested by Pliny the Elder of Rome (A.D. 23-79).
Orthodontists use a variety of dental appliances made of metal, plastic, or ceramic; most methods work by exerting steady, gentle pressure over time to move teeth into their proper positions.
WHAT’S NEW: Temperature-sensitive, nickel-titanium alloy — first developed by NASA for the space program — has mostly replaced old-fashioned stainless-steel wires for braces. Another breakthrough: computer software that creates 3-D model simulation, allowing more-precise treatment planning. Cosmetic advances include smaller braces that bond directly to the teeth; no-show, clear ceramic braces, and ones worn on the back of the teeth; and so-called “invisible” braces made with clear plastic aligners that can be removed for easy cleaning.
LITTLE BITES: Kids are still the most common orthodontic patients — three out of four are under age 18. But a growing number of adults opt for braces, too. According to the American Association of Orthodontists, from 1994 to 2010, the percentage of adults getting braces rose 58 percent — up to about 1.1 million a year. And just this spring, celebrity-watchers were atwitter when reality TV star Khloe Kardashian went public with the news that she got “invisible” Invisalign braces — at age 28.
Nice-looking teeth need healthy gums to support them — and that’s where periodontists come in. Gum problems are a key cause of tooth loss. If bleeding and swelling persist, gums can start to pull away from teeth, causing pockets of plaque. The underlying bone can be affected, signaling periodontal disease. Deep-cleaning procedures can nip this disease in the bud; if unsuccessful, gum surgery may be required.
Besides plaque, many factors — everything from smoking to certain medications, pregnancy, even genetics — can lead to periodontal disease. The American Academy of Periodontics estimates that 30 percent of the population may be genetically susceptible to this condition.
WHAT’S NEW: Lasers can “blast away” infected tissue and reshape the gum line. Computer-linked probes permit the periodontist to scrutinize the gums; slow-release antibiotics offer a steady stream of infection-fighting
LITTLE BITES: Moms-to-be should be especially conscious of their oral health: Recent studies suggest that pregnant women with periodontal disease are at an increased risk of giving birth to pre-term or low birth-weight babies.
A prosthodontist specializes in restoration and replacement of teeth. They deal with everything from crowns, bridges, and dentures to cosmetic veneers, inlays, and dental implants. These oral architects tackle congenital mouth deformities and damage from accidents or disease, TMJ and other jaw problems, and sleep disorders that may be linked to the structure of the jaw or mouth.
WHAT’S NEW: Tiny intra-oral cameras magnify areas of the mouth up to 40 times; images can then be displayed on a computer for easier analysis. The computer-controlled “magic wand” injects anesthesia without the pain of a needle.
LITTLE BITES: Prosthodontists sometimes team up with sleep specialists to devise treatments for sleep apnea. Anti-snoring mouthpieces are shaped to the precise contours of a patient’s mouth, which help keep the jaw and tongue from moving out of place.